Healthcare Provider Details

I. General information

NPI: 1033024138
Provider Name (Legal Business Name): SOUTHERN WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 J D MILLER RD BLDG A
SANTA ROSA BEACH FL
32459-0531
US

IV. Provider business mailing address

268 MARQUIS WAY
FREEPORT FL
32439-4457
US

V. Phone/Fax

Practice location:
  • Phone: 850-400-8441
  • Fax:
Mailing address:
  • Phone: 850-400-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY DAWN LINDSEY
Title or Position: OWNER AND MANAGER
Credential:
Phone: 850-400-8441